Provider Demographics
NPI:1720019102
Name:SANUSI, MICHAEL O (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:O
Last Name:SANUSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 LADSON CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5379
Mailing Address - Country:US
Mailing Address - Phone:470-493-4267
Mailing Address - Fax:
Practice Address - Street 1:504 LADSON CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5379
Practice Address - Country:US
Practice Address - Phone:470-493-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54002208600000X, 208G00000X
GA057666208G00000X
GA57666208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery